Dietary Acid Load and Mental Health Outcomes in Children and Adolescents: Results from the GINIplus and LISA Birth Cohort Studies.

Judith Bühlmeier,Tamara Schikowski,Manuel Föcker,Johannes Hebebrand,Sibylle Koletzko,Carl-Peter Bauer,Irina Lehmann,Joachim Heinrich,Dietrich Berdel,Carla Harris,Andrea Von Berg,Lars Libuda,Marie Standl

doi:10.3390/nu10050582

Abstract

High dietary acid load may have detrimental effects on mental health during childhood and adolescence. We examined cross-sectional and prospective associations of dietary acid load and mental health problems in a population-based sample, using data from the German birth cohort studies GINIplus (German Infant Nutritional Intervention plus environmental and genetic influences on allergy development) and LISA (Influences of lifestyle-related factors on the immune system and the development of allergies in childhood). These studies included detailed assessments of dietary intake through a food frequency questionnaire (FFQ), mental health outcomes measured through the Strengths and Difficulties Questionnaire (SDQ), and covariates. Using logistic regression, cross-sectional associations between dietary acid load measured as potential renal acid load (PRAL) and SDQ subscales were assessed at age 10 years (N = 2350) and 15 years (N = 2061). Prospective associations were assessed, considering PRAL at 10 years as exposure and SDQ subscales at 15 years as outcome (N = 1685). Results indicate that children with a diet higher in PRAL have more emotional problems (OR = 1.33 (95% CI = 1.15; 1.54); p < 0.001), and show hyperactivity more often (1.22 (1.04; 1.43); p = 0.014) at 10 years. No significant associations were present either cross-sectionally at age 15 years, nor prospectively. Results were confirmed in sensitivity analyses. These findings reveal first evidence for potential relationships between PRAL and mental health in childhood, although we cannot exclude reverse causality, i.e., that dietary behavior and PRAL are influenced by mental status. Future studies should address confirmation and identify biological mechanisms.

Highlights

According to the World Health Organization (WHO), mental disorders are a growing burden worldwide, and many of them begin in childhood or early adolescence [1]
Results from cross-sectional analyses, where cases were defined as “borderline/abnormal”, indicated significant positive associations of prospective associations of diet-induced acid load (PRAL) with emotional problems (OR = 1.33)
The main analyses show that higher dietary acid loads are associated with greater odds of emotional problems and hyperactivity in children at the age of 10 years, while no cross-sectional or prospective associations were observed in adolescents

Summary

Introduction

According to the World Health Organization (WHO), mental disorders are a growing burden worldwide, and many of them begin in childhood or early adolescence [1]. The acid load of a Mediterranean diet was revealed to lie between those of vegetarian and omnivore diets (mean PRAL: −2 mEq/d (95%CI −5; 2) [13]), as it is characterized by mainly, but not exclusively, plant-based meals. In contrast to those net-base producing diets, net-acid producing diets constitute a moderate, but continuous demand of the body’s buffer systems, and are discussed as one cause of chronic diseases such as osteoporosis and cardiovascular disease [14,15]

Methods

Results

Discussion

Conclusion